NPI | 1275939332 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA58902) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA MAPA5192) |
363AM0700X Physician Assistant, Medical (Licence: MA PA5192) | |
Enumeration Date | 2014-11-17 |
Last Update Date | 2021-03-26 |